Structured Abstract

Purpose:

We compared the effectiveness and harms of oral or topical nonsteroidal antiinflammatory drugs (NSAIDs) in the treatment of chronic pain from osteoarthritis, rheumatoid arthritis, soft tissue pain, back pain, and ankylosing spondylitis.

Data Sources:

We searched Ovid MEDLINE® and the Cochrane Library and the Database of Abstracts of Reviews of Effects through May 2010. For additional data we also hand searched reference lists, US Food and Drug Administration medical and statistical reviews and dossiers submitted by pharmaceutical companies.

Review Methods:

Study selection, data abstraction, validity assessment, grading the strength of the evidence, and data synthesis were all carried out according to standard Drug Effectiveness Review Project review methods.

Results and Conclusions:

For pain relief, no significant short-term (< 6 months) differences were found among oral NSAIDs, topical NSAIDs, or between oral and topical NSAID. For serious harms, celecoxib does not appear to be associated with higher risk of cardiovascular events and is gastroprotective in the short term compared with nonselective NSAIDs. These findings vary by subgroup, depending on age, recent history of gastrointestinal bleeding, and concomitant use of antiulcer medication. Nonselective NSAIDs were associated with similar increased risks of serious gastrointestinal events, and all but naproxen were associated with similar increased risk of serious cardiovascular events, but the partially selective NSAID nabumetone was gastroprotective compared with nonselective NSAIDs. Compared with oral NSAIDs, topical diclofenac was gastroprotective but had higher risk of application site dryness. Application site reactions and withdrawals due to adverse events were higher with diclofenac 1.5% topical solution but not with diclofenac 1.0% topical gel compared with placebo.

Acknowledgments: We thank Leah Williams, our publications editor, for putting this report into its present form for you to read. We also thank Kevin Arce DMD, MD, MCR and Shelley Selph, MD, MPH for assistance with data abstraction and quality assessment of studies, Allison Low for assistance with data abstraction, and Theresa Nguyen and Allison Low for retrieval of articles and assistance with editing and formatting.

Funding: The Drug Effectiveness Review Project, composed of 12 organizations including 11 state Medicaid agencies and the Canadian Agency for Drugs and Technology in Health, commissioned and funded for this report. These organizations selected the topic of the report and had input into its Key Questions. The content and conclusions of the report were entirely determined by the Evidence-based Practice Center researchers. The authors of this report have no financial interest in any company that makes or distributes the products reviewed in this report.

The purpose of Drug Effectiveness Review Project reports is to make available information regarding the comparative clinical effectiveness and harms of different drugs. Reports are not usage guidelines, nor should they be read as an endorsement of or recommendation for any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.